SANTIAM MOBILE MEDICINE LLC
NPI 1750899035
Nurse Practitioner in Stayton, OR

Q: What is Santiam Mobile Medicine LLC's NPI number?

The NPI number for Santiam Mobile Medicine LLC is 1750899035. It was assigned to this organization in the NPPES registry on January 20, 2018.

Q: What is Santiam Mobile Medicine LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since January 20, 2018CLIA 38D2146974 · Waiver

41805 STAYTON SCIO RD SE, STAYTON, OR 97383(503) 507-5356(866) 225-2708 Get Directions Write a Review

NPPES record last updated: May 31, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 31, 2025, Jan 27, 2021, Jul 1, 2020 and 3 more (6 updates tracked since 2018).

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About Santiam Mobile Medicine Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SANTIAM MOBILE MEDICINE LLC (NPI 1750899035) is a healthcare organization registered as a nurse practitioner in Stayton, Oregon and active in the NPI registry since January 2018. The organization holds a CLIA Waiver certificate valid through April 9, 2028 and lists Casey Lulay, Member, as its authorized official.

NPPES Registry Identity

NPI1750899035

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameSANTIAM MOBILE MEDICINE LLC

Location Address41805 STAYTON SCIO RD SEStayton, OR 97383-9739

Mailing AddressPo Box 118Stayton, OR 97383-0118 · (503) 507-5356 · Fax (866) 225-1708

Phone(503) 507-5356

Fax(866) 225-2708

Organization SubpartNo

Authorized OfficialCasey LulayMember · (503) 507-5356

Enumeration DateJanuary 20, 2018

Last NPPES UpdateMay 31, 20256 updates tracked since enumeration

NPPES CertifiedMay 31, 2025

✔ NPI 1750899035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

41805 STAYTON SCIO RD SE, Stayton, OR 97383

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Other Identifiers 2

Medicaid500673258OR

Medicaid500779652OR

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Santiam Mobile Medicine Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 6 clinicians reassign Medicare billing to Santiam Mobile Medicine LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.